Gout and diet
The high levels of uric acid that lead to gout have a variety of causes, some of which relate to our kidneys and liver but most cases of gout are due to our diet and lifestyle. Gout attacks can be brought on quite predictably when susceptible people eat a large amount of foods rich in ‘purines’. Purines cause uric acid levels to rise in the blood and it is the crystallisation of uric acid in the joints that increases the chance of the excruciating pain of a gout attack by up to 5-fold.
Can we do more to protect against gout than avoiding those purine-rich foods though?
High levels of supplemental vitamin C have been shown to increase the excretion of uric acid by the kidneys. For example, very high doses of 8g a day for 3-7 days were shown to reduce blood levels of uric acid by 2-3mg/dL(1), though such speedy clearance might actually increase the chance of a gout attack in the short term.
More moderate levels of vitamin C from dietary supplements such as 500mg have been shown to reduce blood uric acid levels by 0.5mg/dL when taken over a period of 2 months(2). For comparison, the placebo group saw no change at all. When you consider that a level of around 6mg/dL is indicative of gout, you can see what a difference this could make.
Perhaps the most impressive trial was one that lasted 20 years and involved around 50,000 male health professionals. Analysing dietary and supplementary vitamin C intake, this huge endeavour found that the higher the intake of vitamin C, the more protection from gout(3).
But is benefit possible through dietary sources?
While dietary mistakes can trigger gout attacks, the avoidance of trigger foods (see prevention below) will help prevent them. Similarly, the amount of vitamin C obtainable through the diet should, over time, help reduce blood levels of uric acid and therefore make an attack less likely. Can we get to 500mg through dietary sources? Easy.
- An average sized red bell pepper weighs 160g. Half of that will supply around 145mg vitamin C.
- Kale is the latest wonder veg. 100g of it will give 120mg vitamin C.
- 110g Broccoli will deliver 100mg vitamin C (as will 130g of sprouts if you like that sort of thing).
- Guavas come in different sizes, but just 100g will supply a huge 228mg of vitamin C.
- Standard servings of various berries, citrus fruits such as oranges, green leafy veg, a kiwi and peas will all provide around 60-100mg of vitamin C too, so it’s incredibly easy to eat enough to lower uric acid.
Can’t imagine eating fruit every day? Try buying a bag of frozen berries, or some kale and pop a handful into a blender for a breakfast smoothie. Here are 4 delicious examples:
These are the main trigger foods for gout attacks and should be religiously avoided of you’re prone to gout:
- Offal (sweetbread, heart, liver, kidney)
- Game (pheasant, rabbit, guinea foul)
- Seafood (cods roe, caviar, mussel, crab, shrimp and other shellfish)
- Oily Fish (herring, mackerel, anchovy, trout, sardine, whitebait, sprats)
- Yeast extracts (marmite, bovril, gravy, beer)
Beware also processed foods containing high fructose corn syrup, a cheaper sweetener than even plain and simple sugar. It is heavily linked to the development of gout, as are the raft of health problems that result from this substance and refined sugars in general, such as obesity, high cholesterol, high blood sugar, high blood pressure. Collectively these are known as ‘metabolic syndrome’, a health picture that generates a lot of additional inflammation from the internal visceral fat that develops a big, hard belly. More inflammation only exacerbates conditions like gout.
High dose vitamin C tablets are widely available but multi-gram daily doses are best reserved for short term use and can potentially loosen the tummy. More moderate strength products are safer for long term use to supplement the dietary sources. Our Nature C is made from real food, so has higher bioflavonoid levels which increase vitamin C activity, itsretention in the body and strengthen cartilage tissue against uric acid crystal formation.
Anecdotal evidence and some small clinal trials have supported cherry juice as a way of preventing gout. Cherry juice supplies a little vitamin C but more importantly has some anti-inflammatory properties.
Conventional treatment for gout is usually a drug called allopurinol which reduces uric acid formation. Once on it, it is taken for life if you don’t address the underlying causes of gout. Allopurinol is ideally prescribed several weeks after a gout attack, as the drug can actually trigger a gout attack if taken too soon.
As a general principle, we’d prefer people to use medicines (whether natural or conventional) for non-life threatening conditions such as gout to help get an initial grip of their symptoms rather than be on them for life. Given the risk factors for gout, simply taking medicine doesn’t encourage people to address these other health issues. We’d encourage all those suffering the agony of gout to try the dietary changes above as necessary and enjoy making the recipes linked to this article for a more healthy life overall.
(3) Choi HK, Gao X, Curhan G. Vitamin C Intake and the Risk of Gout in Men – A Prospective Study. Archives of internal medicine. 2009;169(5):502-507. doi:10.1001/archinternmed.2008.606.
Originally written on 18/01/2016, updated on 03/10/2018